Article

Association of Lubricant Use with Women's Sexual Pleasure, Sexual Satisfaction, and Genital Symptoms: A Prospective Daily Diary Study

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Abstract

Introduction. Although lubricant use is commonly recommended to women for solo and partnered sexual activities, little is known about women's use of lubricant or their relationship to sexual pleasure and satisfaction. Aim. The aim of this study was to assess: (i) how adult women used lubricant during partnered and solo sexual activities; (ii) relations between women's reports of sexual pleasure and satisfaction and their use of a lubricant during a particular sexual event; and (iii) to what extent lubricant use was associated with subsequent genital symptoms. Methods. A total of 2,453 women completed a 5-week internet-based, double-blind prospective daily diary study in which they were assigned to use one of six water- or silicone-based lubricants. Main Outcome Measures. Baseline data included demographics, contraceptive use, and sexual behavior during the 4 weeks prior to study enrollment. Daily diary data included reports of penile–vaginal sex, penile–anal sex, solo sex, lubricant use, lubricant application, ratings of sexual pleasure and satisfaction, and genital symptoms. Results. Water-based lubricants were associated with fewer genital symptoms compared with silicone-based lubricants. In addition, the use of a water-based or silicone-based lubricant was associated with higher ratings of sexual pleasure and satisfaction for solo sex and penile–vaginal sex. Water-based lubricant use was associated with higher ratings of sexual pleasure and satisfaction for penile–anal sex as compared with no lubricant use. Conclusion. The water- and silicone-based lubricants used in this study were associated with significantly higher reports of sexual pleasure and satisfaction and rarely associated with genital symptoms. Herbenick D, Reece M, Hensel D, Sanders S, Jozkowski K, and Fortenberry JD. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: A prospective daily diary study. J Sex Med 2011;8:202–212.

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... Lubricants can be used for various reasons-to facilitate comfortable childbirth, gynecological and rectal examinations, sexual intercourse, amelioration of vaginal dryness and for increasing sexual pleasure (Braunstein & Van de Wijgert, 2005;Herbenick et al., 2011Herbenick et al., , 2013Hoffman et al., 2010;Jozkowski et al., 2013;Sutton, Boyer, Goldfinger, Ezer, & Pukall, 2012), or as a medium for medicinal products, such as microbicides. Personal or additional lubricants are "supplied separately and applied to the condom, vagina, penis or rectum at the time of intercourse, [and] are sometimes used to improve lubrication, moistening and comfort during intercourse" (World Health Organization, 2012b). ...
... It is therefore important to be familiar with sexual practices, reasons for them, and implications of these before marketing products such as lubricants or gels (Braunstein & Van de Wijgert, 2005). Few studies have addressed women's use of or interest in using lubricants for sexual activities (Herbenick et al., 2011;Sutton et al., 2012). ...
... Individuals who use condoms may also choose to use lubricants or not-and there needs to be consideration of possible interactions of lubricants with condoms (Herbenick et al., 2011;Lee et al., 2016). The UNAIDS guidance note on condom and lubricant programming (UNAIDS, 2014) states that water-or silica-based lubricants should always be made available with condoms, ensuring availability to high-risk groups, such as MSM, sex workers and their clients, those who have casual partners and postpartum women. ...
Article
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Personal or additional lubricants are used by individuals to enhance sexual experience. Lubrication norms during sex are linked to factors including sociocultural norms, gender dynamics, age, and education. This article provides an overview of literature, exploring thematic areas of interest and relevance to the topic. In some regions/countries, lubricated sex is preferable, and in others, a dry/tight vagina is preferred. Women may use a variety of products to achieve these states. There is little research on lubrication preferences during sex; however, microbicide gel acceptability and adherence studies have provided some insight into these preferences. There is a need for more information on lubrication preferences, including volumes, frequency of use, and site of application. In addition, condom use with lubricants needs further exploration. Context, gender, and individual preferences have implications for acceptability and use of personal additional lubricants and should be taken into account during marketing and dissemination of these products.
... To address the limitations of high condom friction and discomfort, various personal lubricants are used among partners. Such lubricants, typically water-, silicone-or oil-based liquids, decrease discomfort and increase pleasure during intercourse [6,13,14]. Such lubricants are also used to produce a sensation of 'wetness' [6,15], when the body does not produce sufficient natural frictionlowering lubrication (e.g. ...
... Indeed, of a nationally representative sample of Americans, 61.5% of women and 66.1% of men were found to agree that lubricants make sex feel better [17,18]. The mechanism by which discomfort is relieved and pleasure is increased derives from an interplay between reduction in surface friction and increase in perceptions of gliding, wetness or slipperiness [14]. As a consequence of providing decreased friction, personal lubricants may also extend the duration of intercourse, as many male and female partners mutually believe that longer intercourse is more desirable for a satisfactory sexual intercourse experience [20]. ...
... Additional benefits of lubricants include their association with reduced condom breakage [21,22] and slippage [1,23]. There is growing evidence that personal lubricants are becoming a staple of many partners' sexual experiences [14], and thus technology that further improves the sensation of lubrication is highly sought. ...
Article
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Personal lubricants can increase user satisfaction with male condoms by reducing friction and yielding a slippery sensation. However, lubricants pose disadvantages of dilution in physiologic fluids and sloughing away over repeated articulations. To address these drawbacks, a latex surface modification, which becomes lubricious in the presence of physiologic fluid, has been developed and evaluated. This study assesses (i) the frictional performance of the lubricious coating compared to non-coated latex and latex lubricated by personal lubricant, (ii) the level of agreement between human-perceived slipperiness and machine-measured friction, and (iii) human preference for a hypothetical male condom containing the lubricious coating. Friction coefficient of the lubricious coating was 53% lower than that of non-coated latex and approximately equal to that afforded by personal lubricant. A touch test and survey of a small population sample (N = 33) revealed a strong correlation (R² = 0.83) between human-perceived slipperiness and machine-measured friction. A majority of participants (73%) expressed a preference for a condom containing the lubricious coating, agreeing that an inherently slippery condom that remained slippery for a long duration would increase their condom usage. Such a coating shows potential to be an effective strategy for decreasing friction-associated pain, increasing user satisfaction and increasing condom usage.
... Our search yielded 7578 unique references, of which 60 were retained for full-text review ( Figure 1). Ultimately, we identified seven that met the inclusion criteria for the effectiveness review, 4,16-21 twenty-one values and preferences studies, 4,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and no cost studies. A table of excluded studies is provided in Supplementary Table A. ...
... Values and preferences review Overall, 21 studies were included in the values and preferences review (Table 4). 4,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The studies were primarily quantitative (n = 16, 9 of which were cross-sectional), although there were several qualitative studies (n = 4) and a multimethod study (n = 1). Twelve were conducted in high-income countries, but others took place in upper-middle (n = 6), lower-middle (n = 5), and low-income (n = 1) countries. ...
... In three studies that compared water-based lubricant to either no lubricant or an oil-based lubricant, individuals generally preferred waterbased lubricants. 25,39,40 One study found that participants preferred odourless and tasteless lubricants, while another found that lubricant taste or smell did not matter, or participants preferred lubricants without flavour, colour, or smell. 22,28 Reasons why individuals liked lubricants or would choose to use them ranged widely, and included comfort, reduced dryness/pain/discomfort, increased pleasure (for themselves or their partners), their partner's preference, ease of orgasm (e.g. ...
Article
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Promoting sexual health is a World Health Organization (WHO) priority. Lubricants are widely available and used to improve sexual pleasure and reduce pain during intercourse. To inform WHO's self-care interventions guideline, we conducted a systematic review of the peer-reviewed literature to answer the question: does use of lubricants during or prior to sex result in improved sexual health and well-being. We searched PubMed, CINAHL, LILACS and EMBASE on 8 July 2020 for effectiveness, values and preferences, and cost data related to commercially available vaginal and anal lubricants. Data were systematically extracted and qualitatively synthesised. Effectiveness evidence was summarised in GRADE evidence profiles. Seven studies met the effectiveness review criteria. Two randomised trials found lubricant use led to improved female sexual well-being and had no impact on incidence of human papillomavirus (moderate certainty evidence). One observational study with gay and bisexual men showed lubricants were associated with increased reports of pain during receptive intercourse and no difference in pain during insertive intercourse, but a reduced degree of pain in both types of intercourse (low/very low certainty evidence). One observational study with female breast cancer survivors found better outcomes of vaginal dryness and dyspareunia with lubricant use (very low certainty evidence). Twenty-one values and preferences studies from diverse populations globally found that most individuals supported lubricant use for reasons of comfort/reduced pain and sexual pleasure. No cost studies were identified. Although evidence is limited, lubricants appear to offer an acceptable approach to improving sexual health and well-being.
... Some women might be reluctant to introduce a vibrator into their sex life because they are afraid of their partner's reaction, as men might regard it as an indicator of their own lack of virility, penis size, endurance or sexual competence 17,76,77 . Research has shown that a large majority of women who use vibrators are comfortable using a vibrator by themselves (85.0%); however, only 69.6% of women reported that they were comfortable using a vibrator with their partner 14 . ...
... Lubricants are easily accessible and widely used, in both heterosexual men and women as well as in LGBT+-identified people 6,77,113 . A 2019 national online survey from Germany reported that lubricants are used by nearly half of participants with sex toy experience, and to the same extent by women and men 17 . ...
... According to Statista data, 70% of men in the USA over 24 years old admitted to using lubricants for intercourse, masturbation and partnered sexual play, and ~90% of MSM reported lifetime lubricant use [113][114][115] . Lubricant liquids and gels are applied to increase genital sensations and sexual pleasure, minimize dryness and pain during sexual activity, enhance use and insertion of sexual devices into the vagina and anus, reduce friction during intercourse and decrease penile load, for example in the case of patients with Peyronie disease 77 . ...
Article
Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.
... However, there is no evidence to date that they improve urinary incontinence or prevent urinary tract infections. A randomized, double-blind study found that the use of lubricants was associated with higher ratings of sexual pleasure and satisfaction compared with no use [44]. The same study also showed that water-based lubricants were associated with fewer genital symptoms than silicone-based lubricants [44]. ...
... A randomized, double-blind study found that the use of lubricants was associated with higher ratings of sexual pleasure and satisfaction compared with no use [44]. The same study also showed that water-based lubricants were associated with fewer genital symptoms than silicone-based lubricants [44]. ...
Article
Introduction Vulvovaginal atrophy (VVA) is a chronic condition caused by estrogen deficiency. It affects around 50% of postmenopausal women, reducing their general and sexual quality of life as well as the quality of their personal relationships. Aim The aim of this clinical guide is to set out an individualized approach to the management of VVA with topical estrogens and non-hormonal preparations. Materials and methods Literature review and consensus of expert opinion. Summary recommendations An individualized approach is required for the management of VVA. Topical low-dose estrogens are effective and also alleviate urinary incontinence and prevent recurrent urinary tract infections. Women should not be denied long-term use of topical estrogens as long as they feel that this treatment is of benefit to them, because the safety data are reassuring. Non-hormonal preparations (lubricants and moisturizers) should be the first-line treatment for VVA in women taking adjuvant endocrine therapies for cancers considered to be hormone-dependent. They can be used over the long term.
... 40 Personal lubricants are used for a variety of reasons, including the enhancement of sexual pleasure, the reduction of pain and potential injury, as well as the improvement of vaginal dryness. 41 Patients with an abnormal penile aspect ratio as observed in patients with Peyronie's disease may face penile instability and might benefit from the use of lubricants during intercourse to decrease penile axial load. Soft glans syndrome and couples with penile-vaginal disproportion are both reasonable indications for the use of lubricants during sexual activity. ...
... Furthermore, no evidence exists that vibrators enhance or impair the ability to achieve orgasm. 41 In summary, the use of vibrators is safe, and patients should be informed that introducing a vibrator might increase arousal, pleasure, and orgasmic intensity. ...
Article
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Background: Although sex aids have been used in clinical practice for ages, the scientific literature assessing their application in men with sexual dysfunction is limited. Aim: To summarize medical literature regarding scientific uses of the most common sex aids in men with sexual dysfunction and assess their clinical applicability. Methods: An extensive literature review was performed with regard to the use of sex aids in sexual medicine. Our search included journal articles, books, and guidelines in different databases: Embase, PubMed, and Cochrane. The key words were "sex aids," "sex toys," "pornography," "lubricants," "constriction bands," "dildos," "vibrators," "vacuum devices," "external penile devices," and "sex swings" were searched. Date of last search was December 4, 2018. Main outcome measures: We assessed the utility of sex aids in men with sexual dysfunction and formulated recommendations for clinicians. Results: Various sex aids are available for men with sexual dysfunction. We present a comprehensive review of the most common sex aids currently available: pornography, lubricants, constriction bands, dildos, vibrators, vacuum devices, external erectile support devices, and aids to positioning. We discuss their indications, outcomes, precautions, and complications. Clinical implications: This review is intended to provide sexual medicine practitioners and academics an overview of sex aids for men with sexual dysfunction for use in both clinical practice and research. Strengths & limitations: This is a compilation of scientific data for a topic that has broad application in sexual medicine and yet has been poorly addressed in the scientific literature. Because of the lack of sufficient data and the heterogeneous nature of different sex aids, a systematic review could not be performed. Conclusion: Having a comprehensive understanding of the sexual dynamics of individuals and couples combined with the appropriate integration of sex aids may have a positive effect in the treatment of male sexual dysfunctions. Miranda EP, Taniguchi H, Cao DL, et al. Application of Sex Aids in Men With Sexual Dysfunction: A Review. J Sex Med 2019;16:767-780.
... Vaginal dryness negatively impacted women's sexual pleasure (Kı sa & € Ozdemir, 2013), while lubricant use was associated with higher sexual pleasure and reduced pain in women (Herbenick et al., 2011(Herbenick et al., , 2014Schick et al., 2015). A study also indicated that Zestra for Women, a botanical feminine massage oil, enhanced female sexual pleasure and arousal when applied to the vulva (Ferguson et al., 2003). ...
... Research also indicates male condoms and hormonal contraceptives have a negative impact on women's sexual pleasure (e.g., Fennell, 2014;Smith et al., 2014), while lubricant use was associated with higher sexual pleasure and reduced pain (Herbenick et al., 2011(Herbenick et al., , 2014Schick et al., 2015). These should not be read as grounds for sexual pleasure or lack thereof and rather as aspects that need to be understood in the biopsycho-social landscape of sexual pleasure. ...
Article
Objectives To clarify the psychosocial and behavioral factors related to women’s sexual pleasure. Methods: A search was conducted on EBSCO and Web of Science databases using the key terms “female sexual pleasure” and “women sexual pleasure” and following PRISMA guidelines. Results: 76 articles were identified, referring to sexual practices, individual factors, interpersonal factors, societal factors, and ways of enhancing sexual pleasure. Conclusions: Age, sexual experience, arousability, body-esteem, sexual autonomy, and sexual assertiveness seem to benefit women’s sexual pleasure, while sexual compliance and a gender power imbalance seem to compromise it. Additional research regarding non-western and non-heterosexual women is still required.
... A small number of studies has both demonstrated the feasibility of and foreshadowed the scientific potential of these methods. These studies have been limited in their sample selection (e.g., Barrett and Barrett, 2001;Helzer et al., 2006;Kaminer et al., 2006;Kranzler et al., 2004;Lee, Choi, and Beal, 2006;Toll et al., 2006;Vivoda and Eby, 2006), variety of method use (e.g., Armeli et al., 2008;Baer, Saroiu, and Koutsky, 2002;Herbenick et al., 2011;Kiene et al., 2009;Moloney et al., 2009;Park, Armeli, and Tennen, 2004), topical focus (e.g., Armeli et al., 2008;Baer, Saroiu, and Koutsky, 2002;Herbenick et al., 2011;Kiene et al., 2009;Moloney et al., 2009;Park, Armeli, and Tennen, 2004), and time span of data collection (e.g., Aldridge-Gerry et al., 2011;Merz and Roesch, 2011). Although these studies have made important contributions to the usage of new technologies in data collection, few, if any, studies have attempted frequent measurement using self-administered methods on a probability-based sample. ...
... A small number of studies has both demonstrated the feasibility of and foreshadowed the scientific potential of these methods. These studies have been limited in their sample selection (e.g., Barrett and Barrett, 2001;Helzer et al., 2006;Kaminer et al., 2006;Kranzler et al., 2004;Lee, Choi, and Beal, 2006;Toll et al., 2006;Vivoda and Eby, 2006), variety of method use (e.g., Armeli et al., 2008;Baer, Saroiu, and Koutsky, 2002;Herbenick et al., 2011;Kiene et al., 2009;Moloney et al., 2009;Park, Armeli, and Tennen, 2004), topical focus (e.g., Armeli et al., 2008;Baer, Saroiu, and Koutsky, 2002;Herbenick et al., 2011;Kiene et al., 2009;Moloney et al., 2009;Park, Armeli, and Tennen, 2004), and time span of data collection (e.g., Aldridge-Gerry et al., 2011;Merz and Roesch, 2011). Although these studies have made important contributions to the usage of new technologies in data collection, few, if any, studies have attempted frequent measurement using self-administered methods on a probability-based sample. ...
Article
We study the influence of frequent survey measurement on behavior. Widespread access to the Internet has made important breakthroughs in frequent measurement possible—potentially revolutionizing social science measurement of processes that change quickly over time. One key concern about using such frequent measurement is that it may influence the behavior being studied. We investigate this possibility using both a population-based experiment with random assignment to participation in a weekly journal for twelve months (versus no journal) and a large scale population-based journal-keeping study with weekly measurement for 30 months. Results reveal few of the measured behaviors are correlated with assignment to frequent measurement. Theoretical reasoning regarding the likely behavioral response to frequent measurement correctly predicts domains most vulnerable to this possibility. Overall, however, we found little evidence of behavioral response to frequent measurement.
... 22 In a diary study of adult women, sexual pleasure, sexual satisfaction and the prevalence of solo and partnered sexual behaviours varied from day-to-day. 53 In another diary study of romantic and sexual partners, reported levels of relationship and sexual satisfaction vacillated on days with and without reports of sexual activity. 54 Finally, among long-term heterosexual couples, diary-based day-to-day changes in reported intimacy were associated with relationship passion, sexual satisfaction and sexual frequency. ...
Article
Methods: Adult men (n=156) and women (n=192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviour type (no sex, one vaginal sex event, one vaginal sex event+any other sex types, multiple vaginal sex events, any other sex types). Mixed-effect multinomial logistic regression modelled the influence of each sexual motivation on sexual behaviour type (Stata; all p<0.05). 'No sex' was the referent in all models; all models controlled for gender. Results: Participants contributed 14856 total partner-associated diary entries. Most (54%; women: 56.5%, men: 51.2%) were associated with no sex; when sex occurred, the most common behaviour type was one vaginal sex event (13.1%) for women and other sex types (16.4%) for men. Wanting to have sex or perceiving a partner wanted to have sex were the strongest predictors of sexual behaviour type, and were associated with a greater number of reported sexual behaviours. Conclusions: Event-specific sexual motivations are associated with the choice to have sex, and with variation in the chosen sexual behaviours.
... To my knowledge, associations among lubrication, pain reduction, increased tactile sensitivity, and experience of pleasure brought about by visual sexual stimulation in the lab have not yet been demonstrated empirically, but seems a plausible hypothesis to test. The positive associations between use of synthetic lubricant and women's solitary and partnered sexual pleasure have been amply documented (Herbenick et al., 2011). ...
... 11 In one study, both water-based and silicone-based lubricants were associated with higher ratings of pleasure and satisfaction during partnered sexual events. 13 Silicone-based lubrication is much more lubricious than water-based lubrication, but it can cause irritation to vaginal mucosa. 11 Water-based lubricant, in particular, was associated with significantly fewer reports of genital symptoms in relation to penile-vaginal intercourse. ...
Article
Female sexual wellbeing is complex and it’s an important part of a comprehensive approach to women’s health. Unfortunately, this aspect of health often is not discussed during medical appointments which can be isolating for female patients. Low libido is the most common female sexual dysfunction. There are multiple causes of low libido that may be physical, cultural, emotional, medical psychological or due to her relationship with her partner. A healthy lifestyle is one way to help women overcome low libido and a few examples include exercise, mindfulness and yoga. Ultimately, these lifestyle approaches can enhance sexual satisfaction.
... It is noteworthy to mention that many young and old men and women incorporate lubricants into routine sex play either with a partner (during penetration and or foreplay) or during solo self-stimulation. Many report increased orgasmic intensity, decreased latency and overall arousal, enjoyment and overall enhanced sexual pleasure and satisfaction [6]. ...
Article
Full-text available
Genitourinary syndrome of menopause (GSM) is a group of symptoms that encompasses vulvovaginal atrophy (VVA), and affects more than half of all postmenopausal females. There are many etiologies that may cause GSM-like symptoms including declining hormone levels, post partum lactation, medications, and certain medical illnesses. GSM is often under-recognized by both the woman and her health care professional. VVA can cause a constellation of signs and symptoms including irritation, pain burning, and itchiness. Although systemic and local hormonal treatment is often recommended, many women may decline their use or opt for a more conservative approach. Numerous women are opting for over-the-counter products for their dryness solutions, including moisturizers, lubricants, and vulvar washes to help manage these symptoms. There is a lot of consumer confusion concerning these products, and with a plethora of varieties on the market, it is easy for the woman to get confused concerning type of products and the additives and chemical that maybe found within them. This review article summarizes the common characteristics of vaginal moisturizers, lubricants, washes, and dispels some of the misperceptions concerning common chemical/additives found in these products. It is important for the reader to note that trade names of several over-the-counter products are mentioned throughout the manuscript and this should not be interpreted as a specific product endorsement.
... Water-based lubricants appear to be the most effective and well tolerated, as silicone lubricants may be associated with an increase in urogenital symptoms. A randomized trial in the general population of women found that sexual pleasure and satisfaction were significantly higher with the use of a lubricant [20]. Entry pain, penetration pain, and vaginal tearing were lowest with a water lubricant compared with silicone lubricant or no lubricant, for example, entry pain (water 4.1 % vs. silicone 10.6 % vs. no lubricant 9.4 %). ...
Article
Full-text available
There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.
... In general, while daily diary methods likely yield more accurate data compared to recall-based methods, to be useful, they require participants to respond to an acceptable number of daily surveys, preferably on (or close to) the day on which they were assigned. Several past reports suggest that, with appropriate attention to procedures and incentives that encourage adherence, conducting online daily diary studies is feasible among heterosexual adolescents, college students, and adults, yielding response rates ranging from 60-92 % [18,19,23,24]. To date, four unique studies have been conducted with MSM over intervals of 30-90 days, with response rates ranging from 78-84 % [22,[25][26][27]. ...
Article
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MSM continue to represent the largest share of new HIV infections in the United States each year due to high infectivity associated with unprotected anal sex. Ecological momentary assessment (EMA) has the potential to provide a unique view of how high-risk sexual events occur in the real world and can impart detailed information about aspects of decision-making, antecedents, and consequences that accompany these events. EMA may also produce more accurate data on sexual behavior by assessing it soon after its occurrence. We conducted a study involving 12 high-risk MSM to explore the acceptability and feasibility of a 30 day, intensive EMA procedure. Results suggest this intensive assessment strategy was both acceptable and feasible to participants. All participants provided response rates to various assessments that approached or were in excess of their targets: 81.0 % of experience sampling assessments and 93.1 % of daily diary assessments were completed. However, comparing EMA reports with a Timeline Followback (TLFB) of the same 30 day period suggested that participants reported fewer sexual risk events on the TLFB compared to EMA, and reported a number of discrepancies about specific behaviors and partner characteristics across the two methods. Overall, results support the acceptability, feasibility, and utility of using EMA to understand sexual risk events among high-risk MSM. Findings also suggest that EMA and other intensive longitudinal assessment approaches could yield more accurate data about sex events.
... Water-based lubricants have the advantage of being non-staining. An internet-based, double-blind, prospective daily diary study also found that waterbased lubricants are associated with fewer genital symptoms in women, compared with silicone-based lubricants 29 . Excipients acting as humectants, emollients and preservatives are added to water-based lubricants to achieve viscosity, alter water activity, and prevent bacterial contamination, and these will have an impact on pH and osmolality values, which are discussed in further detail in a later section. ...
Article
Full-text available
Vaginal dryness is a common condition that is particularly prevalent during and after the menopause, and is one of the symptoms of vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated. Furthermore, barriers exist to treatment-seeking, and this condition is often underreported and undertreated. Greater education about vaginal dryness and the range of available treatments is essential to encourage more women to seek help for this condition. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. However, there is a distinction between lubricants and moisturizers, and notable differences between commercially available products. Women should be advised to choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions. A series of recommendations for the use of vaginal lubricants and moisturizers, either on their own or in combination with systemic or topical hormone replacement therapy, is presented.
... A study by Grov et al. (2010) used online daily diaries to assess the link between sexual compulsivity, affect and sexual risk behaviour in highly sexually active 'men who have sex with men' (MSM). Similarly, a study by Herbenick et al. (2010) examined female sexual pleasure, sexual satisfaction and genital symptoms in relation to the use of different types of lubricant. In both studies, participants were required to fill out a number of questionnaires each day, which constituted their diary entries. ...
... The resulting painful sexual intercourse that may occur is known as dyspareunia [54], and may significantly hinder sexual function. Personal lubricants deliver reduced friction during intercourse [55,56], and are typically water-, silicone-, or oil-based liquids [57]. They are also often used along with condoms, with the objective of providing improved tissue-biomaterial lubrication. ...
Article
Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.
... 8,11 However, physical awareness of the intravaginal ring did not universally negatively affect sexual experiences; in fact, one participant felt increased sexual pleasure owing to intravaginal ring awareness. Additionally, the spermicide positively affected some users' sexual experiences through its dual effect as a lubricant, which can increase sexual pleasure, 16,17 and participants in this study were able to use effective contraception while minimizing painful experiences such as those during initial penetration. Importantly, rather than solely considering physical products as potential barriers in sexual sensation, they can also act as sexual enhancers. ...
Article
Objective: To elucidate the effects of the intravaginal ring, oral contraceptive pill (OCP), and spermicide plus condom on women's sexual experiences through an in-depth understanding of the physical characteristics of these contraceptive methods. Methods: We conducted qualitative in-depth interviews with women (aged 18-45 years) who used up to three contraceptive methods (intravaginal ring, OCP, and spermicide plus condom). Women completed in-depth interviews after each 3-month use period. We used a summarized matrix framework and thematic content analysis to explore how each method affected participants' sexual experiences. Results: Sixteen women completed interviews, yielding 33 transcripts. Women reported physical effects on their sexual experiences while using the intravaginal ring and spermicide plus condom. The OCP was often discussed as lacking these physical effects. Discussion themes included product administration (eg, navigating intravaginal ring removal) and physical product awareness (eg, spermicide as a lubricant). From these experiences, women often altered and individualized their use and subsequent opinions of the contraceptive method. Conclusion: The range of contraceptive effects on women's sexual experiences shape their use and opinions of the product, leading to either increased motivation and consistent use or poor adherence and discontinuation. Awareness of these individualized experiences can help providers better understand and guide their patients towards successful contraceptive use.
... Vaginal lubricants are used to prevent dryness and dyspareunia during sexual activity [17,18]. Although water-based vaginal lubricants are commonly recommended, many contain preservatives that may aggravate sensitive vaginal mucosa [19,20]. ...
... Современные вагинальные лубриканты не только устраняют или смягчают явления сухости, дискомфорта во влагалище, но и могут способствовать локальному снижению pH и нормализации местного микробиоценоза. Согласно многочисленным исследованиям водорастворимые смазки имеют меньшее число побочных эффектов в сравнении с силиконовыми вариантами [23,24]. ...
Article
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The review presents data on the management tactics of women with vulvovaginal atrophy in patients of reproductive age and menopause. The influence of vulvovaginal atrophy on the psycho-emotional and sexual spheres, modern methods of diagnosis and therapy of this pathology are considered. Special attention is paid to the role of rehabilitation and an integrated interdisciplinary approach to patients with symptoms of atrophic changes in the urogenital tract: the experience of rehabilitation measures is highlighted on the example of foreign and local studies, the effectiveness of "prerehabilitation" at the stage of the period from diagnosis to treatment is indicated. There is still a need for further studies of complex rehabilitation and its implementation in clinical recommendations.
... Lubricants, which are available in water-, silicone-, mineral-, or plant oil-based forms, are applied to the vagina and vulva prior to sex [75]. Waterbased lubricants are often preferred over oil-based lubricants as they are non-staining and associated with fewer genital symptoms [76]. Women should choose a product that is optimally balanced in terms of both osmolality and pH and physiologically most similar to natural vaginal secretions [75]. ...
Article
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Genitourinary syndrome of menopause is a condition comprising the atrophic symptoms and signs women may experience in the vulvovaginal and bladder-urethral areas as a result of the loss of sex steroids that occurs with menopause. It is a progressive condition that does not resolve without treatment and can adversely affect a woman’s quality of life. For a variety of reasons, many symptomatic women do not seek treatment and, of those who do, many are unhappy with their options. Additionally, many healthcare providers do not actively screen their menopausal patients for the symptoms of genitourinary syndrome of menopause. In this review, we discuss the clinical presentation of genitourinary syndrome of menopause as well as the treatment guidelines recommended by the major societies engaged in women’s health. This is followed by a review of available treatment options that includes both hormonal and non-hormonal therapies. We discuss both the systemic and vaginal estrogen products that have been available for decades and remain important treatment options for patients; however, a major intent of the review is to provide information on the newer, non-estrogen pharmacologic treatment options, in particular oral ospemifene and vaginal prasterone. A discussion of adjunctive therapies such as moisturizers, lubricants, physical therapy/dilators, hyaluronic acid, and laser therapy is included. We also address some of the available data on both the patient and healthcare providers perspectives on treatment, including cost, and touch briefly on the topic of treating women with a history of, or at high risk for, breast cancer.
... Depending on the ingredient, lubricants can be divided into water-, silicone-, and oil-based lubricants. Water-based lubricants are most widely accessible, and cause fewer adverse genital symptoms than that observed with lubricants containing other type ingredients [10]. These water-based lubricants contain a bio-adhesive hydrophilic polymer to maintain the moisturizing effect, preservatives to prevent bacterial contamination, and other excipients to maintain pH and osmolality. ...
Article
Postmenopausal atrophic vaginitis, along with vasomotor symptoms and sleep disorders, is one of the most troublesome symptoms of menopause. However, many women do not manage this symptom properly due to insufficient knowledge of the symptoms or sexual embarrassment. With appropriate treatment, many postmenopausal women can experience relief from discomforts, including burning sensation or dryness of the vagina and dyspareunia. Topical lubricants and moisturizers, systemic and local estrogens, testosterones, intravaginal dehydroepiandrosterones (DHEAs), selective estrogen receptor modulators, and energy-based therapies are possible treatment modalities. Systemic and local estrogen therapies effectively treat genitourinary syndrome of menopause (GSM), but they are contraindicated in patients with breast cancer, for whom lubricants and moisturizers must be considered as the primary treatment. Intravaginal DHEA and ospemifene can be recommended for moderate to severe GSM; however, there is insufficient data on the use of intravaginal DHEA or ospemifene in patients with breast cancer, and further studies are needed. Energy-based devices such as vaginal laser therapy reportedly alleviate GSM symptoms; however, the U.S. Food and Drug Administration warning has recently been issued because of complications such as chronic pain and burning sensations of the vagina. To summarize, clinicians should provide appropriate individualized treatment options depending on women's past history, symptom severity, and chief complaints.
... Water, silicone, mineral oil, or plant-based products are applied to the vagina and vulva (if needed these are also applied to the partner's genital). In general, water soluble lubricants are associated with fewer genital side effects than silicone lubricants [31,32]. A single-center randomized double blind and crossover trial in postmenopausal breast cancer patients compared silicone-versus water-based lubricants for sexual discomfort [33]. ...
Article
Objective To develop a best practice document for the management of postmenopausal vulvovaginal atrophy (VVA). Method Literature review carried out using clinical terms, treatments or interventions and comorbidity related to VVA. Results There is a wide variety of interventions that may produce temporal benefits for VVA. However, there are significant limitations in scientific publications concerning VVA and related issues, including variable outcome evaluations, variability in population age range, and small, often underpowered sample sizes. Therapeutic management of VVA should follow a sequential order, considering women’s age, symptoms, general health as well as treatment preference. Beneficial options include lubricants, moisturizers, vaginal estrogens (estradiol, estriol, promestriene, conjugated estrogens), androgens, prasterone, and laser application. In women with general menopausal symptoms who are candidates for systemic hormone therapy, the lowest effective dose should be used. Oral ospemifene is an effective selective estrogen receptor modulator to treat VVA. Systemic androgens have a limited role. Although laser procedures are commonly used, at this moment the International Society for the Study of Vulvovaginal Disease does not endorse its use out of the setting of clinical trials. Pelvic floor muscle training improves blood flow and elasticity of the vulvovaginal tissue. In breast cancer survivors, moisturizers and lubricants are first line therapy. However, limited absorption of low/ultra-low doses of estrogens suggests safety, especially in women under treatment with aromatase inhibitors. As clinical practice and available preparations vary between countries this text should be adapted to local circumstances. Conclusions There is a wide range of therapeutic options to individualize VVA treatments.
... In addition, tissue integrity, elasticity, and pliability are improved. Moisturizers are constituted by water and other substances such as hyaluronic acid or polycarbophil (14,15). ...
Article
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The estrogen decrease in postmenopausal women results in functional and anatomical changes in the genitourinary tract. The most prevalent and bothersome symptoms are vaginal dryness, dyspareunia, and reduced lubrication, which can significantly affect the quality of life of these women, principally those who are sexually active. Hormonal therapy with local estrogens is generally considered the “gold standard.” However, there are cases in which there are clinical concerns about its use or women opt for non-hormonal options. Thus, safe and effective non-hormonal options are needed to improve symptoms in these women. Moisturizers and lubricants are first-line therapy for breast cancer survivors.
... Participants were also provided with Wet Plantinum ® siliconebased personal lubricant to facilitate insertion. Both SKYN ® condoms and Wet Platinum ® have been used in other sex research studies (Herbenick et al., 2011;. In a study examining the impact of personal lubricants on epithelial cell monolayers, Wet Platinum ® was found to be non-toxic and the safest of the five lubricants tested (Russo et al., 2010). ...
Article
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Forty years ago, researchers documented changes in vascular and muscular activity within the anal canal of women and men who engaged in sexual self-stimulation. Vascular changes were assessed using a photoplethysmograph that aimed to detect changes in pelvic vasocongestion. An important advantage of detecting sexual response within the anal canal is that the device, its anatomical placement, and the data output are identical for women and men, therefore facilitating gender comparisons of response patterns. In this study, the vaginal photoplethysmograph (VPP), the most common measure of genital response in women, was administered intra-anally as an anal photoplethysmograph (APG) to examine its validity and sensitivity as an indicator of sexual response. The final sample comprised 20 women and 20 men who were exposed to 12, 90-s sexual and nonsexual film clips while their APG responses were recorded. Participants also rated their sexual arousal and affective responses to the stimuli. There was evidence that APG responses were specific to sexual stimuli and were sensitive to erotic intensity in women. The degree of discrimination between sexual and nonsexual stimuli was lower in men. Unlike most sexual psychophysiological studies, the positive correlation between physiological and self-reported sexual arousal was stronger in women than in men. There was a relatively high number of data artifacts and the waveform morphology was uncharacteristic of that typically observed with VPP. The potential role of anal musculature interference on the APG signal is discussed, as well as avenues for future research.
... Personal lubricants are used to enhance sexual enjoyment [17,18] and increase acceptability of condom-use [19,20]. Lubricants also reduce the discomfort of clinical speculum examinations [21,22] and are often recommended for symptomatic relief of some vulvovaginal symptoms associated with the genitourinary syndrome of menopause [23,24]. ...
Article
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The outer layers of the vaginal epithelium (VE) are important because they accumulate glycogen which, under optimal conditions, Lactobacillus spp. consume to grow and acidify the vaginal microenvironment with lactic acid. We hypothesized that exposure to lubricant, for example in the conduct of a transvaginal ultrasound (TVUS), may contribute to the shedding of mature epithelial cells, exposing immature cells. Cervicovaginal fluid (CVF) was sampled at four time points by menstrual cup (Softdisc™) from 50 women referred for TVUS, during which a controlled volume of lubricant was applied to the TVUS wand. Samples were collected (1) immediately before TVUS and (2) 6-12 hours, (3) within one week, and (4) two weeks after TVUS. Clinical vaginal lubricants are similar to commercial lubricants, and often have a high osmolality or pH, and contain bactericides such as methylparaben and propylparaben. The number and maturity of epithelial cells in each CVF sample were measured by quantitative and differential fluorimetry (maturity index, MI). Comparisons of cell-counts and maturity were made by paired Wilcoxon signed-rank tests. Among women with a high pre-TVUS MI (> 3), there was a decrease in median cell-count and mean MI in the sample collected 6-12 hours after TVUS (p
... These findings reflected women approaching the menopausal age having a rapid decline in ovarian sex hormone levels, resulting in biological menopause and atrophic changes in the reproductive tracts [19]. Treating physical problems, such as vaginal dryness with moderate lubricant, is helpful and prevent women from experiencing painful intercourse [31]. However, providing physical treatment for these symptoms is not the only way to gain back normal responses to sexual intercourse. ...
Article
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Aims: Previous research has shown the efficacy of culturally adapted Cognitive Behavioral Therapy (CA-CBT) in reducing depression, yet its effect on increasing sexual satisfaction is not well documented. In this study, an embedded randomized controlled trial design was used to examine the effect of group and individual CA-CBT on depression and sexual satisfaction among perimenopausal women. Method: A total of 64 depressed Iranian perimenopausal women were randomly assigned to two formats of treatments; sixteen sessions of group CA-CBT and eight sessions of individual CA-CBT, as well as a waitlist control group. Depression and sexual satisfaction were measured using BDI-II and ENRICH, respectively, at T1 (pre-treatment), T2 (post-treatment) and T3 (follow-up). Results: Repeated measures ANOVA indicated that the women who underwent both group and individual CA-CBT had effectively reduced depression and increased sexual satisfaction between pre-treatment and post-treatment, and it was sustained after six months of follow-ups with large effect sizes of significant differences (p < 0.001), but the control group did not. Conclusion: The results showed promising evidence for the efficacy of both treatment groups of CA-CBT for depression and sexual satisfaction among perimenopausal women. The population mental health burden among perimenopausal women may likely be reduced by propagating this effective treatment.
Article
Background The novel vaginal pH modulator (VPM; Phexxi) is a non-hormonal, woman-controlled, on-demand, water-based, surfactant-free contraceptive vaginal gel; VPM has also been cleared by the Food and Drug Administration for use as a personal lubricant. Aim The aim of this study is to report on sexual satisfaction results from the phase 3 AMPOWER study. Methods AMPOWER was a single-arm, open-label, multicenter study to assess the safety and efficacy of VPM in preventing pregnancy. Women were enrolled who were healthy, age 18-35 years, and sexually active with regular cyclic menses. Outcomes Women's satisfaction (including sexual satisfaction) was an exploratory endpoint measured at Baseline and Visits 3-5; sexual satisfaction-related patient reported outcomes (PROs) were assessed via 3 different questions: (i) a question related to the impact on a woman's sex life; (ii) a question from the Sexual Function Questionnaire (SFQ) related to the frequency of ten sexual problems; and (iii) and a question from the Female Sexual Function Index (FSFI) related to lubrication. Results For sexual satisfaction-related PRO measures with baseline assessments, the majority of women reported the same or improved scores at Visit 5 (ranging from 85.8% to 98.4%). The percentage of women who reported that their sex life was improved and/or maintained was higher in Visit 3, 4, and 5 (95.4%, 95.1%, and 93.6%, respectively) compared to Baseline (87.6%). The mean impact on sex life score significantly improved at Visit 5 compared to Baseline (P < .001). In the SFQ, the mean score significantly improved (P < .005) at Visit 5 vs Baseline in 7 of the 10 variables measured (vaginal dryness, lack of sexual interest and/or desire, vaginal tightness, pain, anxiety, unable to orgasm, and vaginal bleeding or irritation). In women who reported sexual activity in the last 4 weeks, the mean FSFI score also significantly improved from Baseline to Visit 5 (P = .037). Clinical Implications In this post-hoc analysis of the phase 3 AMPOWER study, the PRO results demonstrate a high level of sexual satisfaction with VPM. Strengths and Limitations The primary strength of this analysis was the large study size of 1,330 women. Limitations included the non-randomized study design, the post-hoc nature of the analysis, and the fact that sexual satisfaction was an exploratory endpoint. Conclusion As a non-hormonal, woman-controlled, on-demand, lubricating contraceptive gel, VPM offers women a unique set of benefits with positive impacts on their sexual health. Thomas MA, Morlock R, Dart C, Howard B. Sexual Satisfaction Results With the Vaginal pH Modulator From the Phase 3 AMPOWER Study. J Sex Med 2022;XX:XXX–XXX.
Chapter
Complementary & Alternative Medicine for Prostate and Urologic Health is designed to capture and clinically review the comprehensive database of clinical research articles that support and do not support the utilization of a variety of dietary supplements and other complementary medicines that physicians are exposed to in their daily practice. This is a critical distinction between this book and any other Complementary & Alternative Medicine (CAM) books published to date. Each section of the book provides an easy to reference guide into the topic of interest for the individual that works in urology. The various sub-specialty groups in urology are adequately represented, which allows for a physician to rapidly and thoroughly investigate their topic of interest regardless of whether it is fertility, bladder cancer, or prostate disease. Rather than having to sort through the now thousands of articles published yearly on CAM in medicine, this volume focuses first on the specialty and secondarily how it compares to the overall CAM literature. Each chapter includes a summary page that will allow the physician a rapid review of the subject with a patient, colleague or student. The practical nature of this book in urology also cannot be overstated. Chapters include a general overview of the CAM agent, whether or not it has data in medicine and urology, and a list of potential drug interactions and specific clinical scenarios where it can be utilized or discouraged in the specialty. Complementary & Alternative Medicine for Prostate and Urologic Health represents a gold standard text for use in teaching, not only for the students interested in the urologic field but for all current urologic health providers.
Article
The proportion of women of perimenopausal and postmenopausal age increases every year. Hormonal changes which are typical for these women are characterized by hypoestrogenism and a great diversity of clinical signs, e.g., vaginal dryness, irritation, itching, pain, burning, dyspareunia, and frequent urination. These symptoms occur at any age but are more common in postmenopausal women. Genitourinary syndrome of menopause (GSM) significantly reduces the quality of life of postmenopausal women. Among GSM presentations, vulvovaginal atrophy affects only vulvar and vaginal mucosa. Managing vulvovaginal atrophy in women of various ages is an important issue of gynecological practice. This paper describes current approaches to the treatment for vulvovaginal atrophy in women of various ages with a special focus on the association between vaginal dryness and the reduction of both general and sexual quality of life. In particular, non-hormonal topical medications are discussed. Knowing current (including international) approaches to address vaginal dryness are important for obstetrical gynecological practice. KEYWORDS: genitourinary syndrome of menopause, vulvovaginal atrophy, lubricants, vaginal moisturizers. FOR CITATION: Tazina T.V., Knyazeva A.V., Bebneva T.V. Current management of vaginal dryness. Russian Journal of Woman and Child Health. 2021;4(3):250–253 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-250-253.
Article
Purpose: While previous research suggests that lubricant use may be common among lesbian- and bisexually-identified women, it remains unclear from this research whether lubricant was being used with a male or female partner. The present study explores the behavioral, emotional, situational, and relational aspects of lesbian- and bisexually-identified women's lubricant use during their most recent female-partnered sexual event. Methods: Nationally representative data was collected as part of the 2012 National Survey of Sexual Health and Behavior (NSSHB). The 2012 NSSHB had an oversample of lesbian, gay, and bisexual (LGB) individuals. Participants were included in the present study if they identified as a lesbian or bisexual women and indicated that their most recent sexual partner was a female. Participants were asked a variety of questions about the context and experience of lubricant use during this event. Results: Nearly a quarter (21.9%, n=32) of the participants reported that they used a lubricant during their most recent female-partnered sexual event. The likelihood of lubricant use significantly differed based upon age, race/ethnicity and sexual identity. The most commonly reported reason for lubricant use was to "make sex more comfortable," with half reporting use for clitoral stimulation (50.6%, n=16). Overall, participants indicated that lubricant use enhanced their sexual experience. Conclusion: Lubricant use may improve comfort and increase pleasure during certain sexual acts between women. The use of lubrication should be considered as a means of reducing pain and enhancing sexual pleasure during sexual behavior between women.
Article
Introduction: The diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level. Aims: The aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States. Methods: Data were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older. Main outcome measures: We examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used. Results: A majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex. Conclusions: Lubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly.
Article
Despite the frequent depiction of heterosexual anal sex in pornography, and growing indications that heterosexual couples engage in anal sex, almost no research has examined women's subjective experiences with receptive anal sex with men. This study draws upon qualitative interviews with 20 American women (mean age=34, SD=13.35) from diverse ages and backgrounds to illuminate five themes in women's narratives about receptive anal sex: (1) initial resistance followed by submission; (2) initial interest followed by withdrawal from subsequent anal sex experiences; (3) violence and coercion surrounding anal sex; (4) social norming (e.g. men's male friends normalizing heterosexual anal sex; seeing anal sex as normative after watching pornography); and (5) pleasurable experiences with anal eroticism. Implications for the re-evaluation of consent, imagining a continuum of sexualized violence, heteronormative assumptions about access to and power over women, silences surrounding non-penetrative anal eroticism, and women's (dis)engagement with anal sex are explored.
Conference Paper
Background: A major hallmark of sexual assault prevention education is consent promotion. As such, sexual consent has been examined almost exclusively in the context of sexual assault. However, alternative initiatives for prevention education which promote proactive and enthusiastic consent may be beneficial to decrease rates of sexual assault and work toward enhancing individuals' sexual experiences. The current study examined consent outside of a sexual assault framework by assessing consent's relation to individuals' perception of the quality of sexual intercourse while controlling for alcohol consumption, relationship status, age, and gender. Methods: College students (n=640) were recruited to participate in a survey assessing their most recent engagement in sexual intercourse. Hierarchical regression was conducted: alcohol consumption, relationship status, and age were entered in step 1; the Internal and External Consent Scale factors were entered in step 2. Two separate models were run for women and men. Results: For women, three factors (Comfort/Safety; Agreement/Wantedness; Physical Response) on the Internal Consent Scale explained a significant proportion of variance in quality of intercourse beyond variables in step 1 (DR2=.17, p DR2=.23, p<.001). Implications: Preliminary findings suggest that consent influences quality of sexual intercourse. Such findings could be utilized to develop more affirmative models of sexual violence prevention that highlight the need for consensual, pleasurable sexual encounters for individuals of all genders.
Chapter
It is critical to keep in mind, especially in this chapter that multiple lifestyle options exists that can improve or actually not improve and even exacerbate side effects from cancer treatments. And there are many integrative medicines, especially dietary supplements that can improve, have no impact or actually cause a side effect from cancer treatment to become worse! The purpose of this chapter just like the rest of this book is to cover all of those integrative medicines that work, have no effect or are worthless for multiple cancer treatment side effects. When applicable prescription drug treatments are mentioned and reviewed. Still, this chapter and the book is not intended to provide a summary or exhaustive list of the conventional prescription treatment options for these side effects from A to Z because it would not only create an unreadable voluminous text, but this also would not serve the purpose of this text—to simply provide a non-biased and objective review of the medical research in the area of breast cancer and integrative medicines, especially in regard to lifestyle changes and dietary supplements. This is the area of oncology that appears to have arguably the greatest current needs for more objective and educational attention to this issue.
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Sexual function in cervical cancer survivors declines significantly after treatments irrespective of the modality used. Only a few studies have looked at their psychosexual needs, perception, and acceptance of psychosexual support. This review summarizes findings of current qualitative as well as quantitative studies to understand the plight of cervical cancer survivors regarding sexual dysfunction and the management issues. The effect of gynecologic cancers on sexuality depends on multiple factors such as psychosexual factors, biologic factors, and age. Younger patients have poorer outcomes with a more pronounced impact on sexual well-being. Radicality of surgery has direct correlation with sexual dysfunction. Low or no sexual interest, lack of lubrication, dyspareunia, and reduced vaginal caliber are frequently found. For too long, researchers have focused on defining the prevalence and types of sexual problems after various cancer treatments. The area that continues to be neglected is the evaluation of effective interventions to prevent or treat cancer-related sexual dysfunction. In particular, mental health and medical specialists need to collaborate to create cost-effective treatment programs. Collaborative intervention with gynecologists, sexologists, radiotherapists, and nursing staff would be beneficial to optimize the sexual wellness of cancer survivors and their spouses.
Article
Female sexual pain disorder or genito-pelvic pain/penetration disorder (GPPPD), previously known as dyspareunia, is defined as persistent or recurrent symptoms with one or more of the following for at least 6 months: marked vulvovaginal or pelvic pain during penetrative intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of penetration, and marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. In this review, we discuss etiology, diagnosis, and treatment for common disorders that cause GPPD.
Article
Objectives Research examining sex among college students has frequently focused on negative sexual experiences. This study aimed to understand situational predictors of various dimensions of students’ sexual experiences. Methods: 427 college students participated in a 60-day daily survey; 213 reported sex and were asked questions about each sexual encounter. Results: 1,664 sexual encounters were reported. 72.5% were described as very pleasurable, 26.6% as lacking communication, and 9.1% as lacking control. Factors associated with pleasure, control, and communication included partner type and emotional closeness. Substance use and partner age were associated with outcomes differently by gender. Conclusions: Sexual health interventions for college students should focus on communication and pleasure.
Article
The objective of this study was to investigate women's willingness to experiment with new condoms and lubricants, in order to inform condom promotion in a city with high rates of poverty and HIV. One hundred and seventy-three women (85.9% Black) sexually transmitted infection clinic attendees in Jackson, Mississippi, United States completed a questionnaire assessing willingness to experiment with condoms and lubricants and sexual pleasure and lubrication in relation to last condom use. Most women were willing to: (1) experiment with new types of condoms and lubricants to increase their sexual pleasure, (2) touch/handle these products in the absence of a partner, and (3) suggest experimenting with new condoms and lubricants to a sex partner. Previous positive sexual experiences with lubricant during condom use predicted willingness. The role women may play in male condom use should not be underestimated. Clinicians may benefit women by encouraging them to try new types of condoms and lubricants to find products consistent with sexual pleasure.
Article
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Vibrators are an evidence-based treatment for a variety of sexual dysfunctions and sexual enhancement; however, the use of a genital vibrator lacks best practice recommendations. This aim of this article is to provide current, best practice recommendations regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual or relationship enhancement. A multidisciplinary team of sexual health specialists collaborated to develop best practice recommendations based on a narrative literature review. Recommendations for the use of vibratory stimulation for the treatment of sexual dysfunction are provided, with special attention to counseling patients on choosing and safely using a vibrator. Further study is needed to determine the most effective methods to counsel patients on vibrator use and to provide evidence-based cleaning recommendations.
Article
Genitourinary syndrome of menopause (GSM) describes a collection of exam findings and bothersome symptoms associated with estrogen deficiency involving changes to the labia, introitus, clitoris, vagina, urethra, and bladder. Vulvovaginal atrophy is a component of GSM. GSM is a highly prevalent medical condition with adverse effects on the health and quality of life of midlife women. There are many effective treatment options, including nonhormonal lubricants and moisturizers, physical therapy, low-dose vaginal estrogen therapy, vaginal dehydroepiandrosterone, and oral ospemifene. Despite the availability of safe and effective therapies, GSM often remains unrecognized and untreated.
Article
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Studies from English-speaking countries show that sex toy use is common in various populations and often associated with sexual well-being. Empirical data on sex toy use and perceived effects in other countries is still missing. Based on the Positive Sexuality framework and the Positive Technology framework, this study documented the prevalence of sex toy use in solo and partnered sex among heterosexual-identified women and men in Germany, as well as perceived positive and/or negative effects of sex toy use on sexual well-being. A survey was conducted with a national online sample of 1,723 heterosexual-identified adults in Germany (Mage = 42.71, SD = 13.25, 49% women, 51% men). The majority (52%) reported sex toy use in partnered sex, and 45% reported sex toy use in solo sex. Stronger positive than negative perceived effects of sex toy use were reported by women and men alike. Findings indicate that professionals in sexual health/sexuality education should consider sex toy use as a common and beneficial sexual behavior. Future studies could explore specific effects of sex toy use and their predictors in more detail.
Article
Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.
Article
Background There are different approaches to improving sexual function among menopausal women including Kegel exercise and using lubricant gel. However, it is not clear which of these methods could be more effective. This study aimed to compare the effectiveness of these two methods on sexual function in menopausal women. Methods The present randomized trial was conducted on 150 menopausal women in Dezful, Iran. Eligible women were randomly assigned to two interventions (Kegel exercise and lubricating gel) and one control groups. The Kegel exercise group received training on the exercise method; the lubricant gel group was given the lubricating gel and taught how it should be used, while the control group received no intervention. The interventions continued for 12 weeks, and sexual function was assessed at four times: baseline, one month, two months, and three-months follow-up. Chi-square test, one-way analysis of variance, repeated measures, analysis of covariance, and logistic regression analyses were applied. Results No significant difference was found between groups regarding demographic and obstetrics variables. After adjusting for the baseline sexual function score, covariate analysis showed a significant improvement in sexual function in Kegel and gel groups as compared to the control group. Similarly, within-group comparison using repeated measures analysis showed that sexual function in both Kegel and gel groups improved during the study follow-up periods while women in the control group showed no changes in their sexual function. Finally, logistic regression analysis indicated a significantly higher odds ratio for better sexual function in both Kegel and gel groups. However, the odds of better sexual function for the Kegel group (OR = 4.19, 95% CI: 1.81-9.72, P = 0.001) was higher than the gel group (OR = 3.7, 95% CI: 1.42-7.52, P = 0.005). Conclusion Both Kegel exercise and gel were effectively improved sexual function in menopausal women. However, the findings indicated that sexual function was more likely to be improved after using Kegel exercise than using lubricant gel. Trial Registration IRCT20150128020854N7. Registered 30 September 2019, https://fa.irct.ir/user/trial/40878/view.
Article
Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality. Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n = 234). Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use. Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.
Article
In ‘Scorekeeping in a Pornographic Language Game’, Rae Langton and Caroline West borrow ideas from David Lewis to attempt to explain how pornography might subordinate and silence women. Pornography is supposed to express certain misogynistic claims implicitly, through presupposition, and to convey them indirectly, through accommodation. I argue that the appeal to accommodation cannot do the sort of work Langton and West want it to do: Their case rests upon an overly simplified model of that phenomenon. I argue further that, once we are clear about why Langton and West's account fails, a different and more plausible account of pornography's influence emerges.
Article
Introduction: The vaginal photoplethysmograph (VPP) is a reusable intravaginal device often employed in sexual psychophysiology studies to assess changes in vaginal blood flow, an indicator of sexual arousal. Aim: To test whether placing a disposable cover on the VPP probe impacts the acquired data. A condom cover would reduce risk of disease transmission and likely increase participant comfort but may negatively impact the VPP signal. Method: The genital responses of 25 cisgender women (mean age = 21.3 years, standard deviation = 2.6) were assessed with VPP in a within-subjects design with 2 conditions-with and without a polyisoprene condom cover. Sexual responses were elicited by audiovisual film clips that varied in erotic intensity: nonsexual (nonsexual male-female interaction), low-intensity sexual (nude exercise), and high-intensity sexual (male-female intercourse). Women continuously rated their sexual arousal during stimulus presentations. Main outcome measure: Change in vaginal pulse amplitude and also self-reported sexual arousal. Results: The magnitude of sexual response to each stimulus category and the overall pattern of results were found to be highly similar in the cover-off and cover-on conditions. The high-intensity sexual stimulus category elicited a greater sexual response than all other categories. The low-intensity sexual category elicited a (small) genital response in only the cover-on condition, although we suspect this is a spurious finding. There was no difference in the average number of edited movement artifacts across conditions. Clinical implications: Potential benefits of encasing the VPP probe with a protective cover include enhanced participant safety and comfort, especially if assessing genital responses of high-risk or immunocompromised samples. The use of a cover complies with current guidelines for reprocessing semi-critical medical devices (eg, vaginal ultrasound probes) in many regions. Strengths & limitations: Although the idea of a VPP probe cover had been discussed among sexual psychophysiology researchers, this is the first study to empirically test whether a cover could jeopardize VPP data. Potential limitations include the use of a 10-Hz VPP sampling rate and a cover that was not tailored to the size of the VPP probe. Conclusion: Placing a protective cover on the VPP probe did not appear to meaningfully impact sexual arousal or the VPP data. Based on these results and the potential advantages of a protective cover, researchers may wish to integrate the use a condom cover in their experiment protocols and clinical applications. Sawatsky ML, Lalumière ML. Effect of a Condom Cover on Vaginal Photoplethysmographic Responses. J Sex Med 2020; XX:XXX-XXX.
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Background Female anal sex is a receptive type of sexual practice among heterosexual couples where the penis is inserted into the anus of a female partner. In the Western world, a number of studies and interventions have been carried out on anal sex among men due to its potential risks to HIV transmission. In African countries, including Tanzania, there is dearth of information on the risks inherent in practices associated with female anal sex in the general population. The objective of this study was to determine the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in selected districts of Tanzania. Methods This study was conducted in four districts of Tanzania of Kinondoni, Tanga Urban, Makete and Siha. Both quantitative and qualitative methods i.e. household interviews and focus group discussions were employed in data collection. Study participants included community members of aged 15 and above such as heads of the household, adolescents, bar workers and commercial sex workers. FindingsA total of 903 individuals were interviewed, 60.6% of whom were females. When respondents were asked to indicate whether they had ever been tempted to practise FAS, 167 (18.5%) reported to have been tempted in the past 12 months. Of these, 44 (26.3%) respondents had at least practised FAS. Risky practices associated with FAS were forced sex, multiple partners, frequency of engaging in FAS, low use of condoms during FAS, low rates of HIV testing among partakers, poor perception of the risks to acquire HIV through FAS and use of lubricants. Conclusions In this population, the frequency of FAS practice was rather low. And yet, FAS practice attendant risk factors are likely to exacerbate HIV transmission. As such, there is a need for further exploratory studies to determine and document drivers of FAS. In addition, public health education should be provided with regard to the risks of contracting HIV associated with FAS practices.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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#### Summary points Recent consensus defined vaginismus as, “The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and or any object, despite the woman’s expressed wish to do so.”1 The definition also noted that affected women often avoid intercourse; experience involuntary pelvic muscle contraction; and anticipate, fear, or experience pain. However, it can be difficult to diagnose vaginismus. Women with total vaginismus are unable to tolerate penetration of their vagina by any object, but those with partial vaginismus tolerate penetration with difficulty and pain. The condition can be lifelong (primary) or it can occur after sexual function has been normal (secondary). It can also be situational, occurring only with certain partners or in particular circumstances, or it can be global, occurring independent of partner or circumstances. It is thus a clinical syndrome, not a definitive diagnosis, that consists of overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration. The Diagnostic and Statistical Manual of Mental Disorders , fourth edition (DSM-IV) categorises vaginismus as a sexual pain disorder along with dyspareunia. It describes vaginismus as occurring when “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina” interferes with intercourse.2 According to this definition, the experience of pain is not necessary for the diagnosis. …
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Although vibrators are commonly recommended by clinicians as adjunct to treatment for female sexual dysfunction, and for sexual enhancement, little is known about their prevalence or correlates of use. The aim of this study was to determine the lifetime and recent prevalence of women's vibrator use during masturbation and partnered sex, and the correlates of use related to sociodemographic variables, health behaviors, and sexual function. A nationally representative sample of 3,800 women aged 18-60 years were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated. The prevalence of vibrator use, the relationship between vibrator use and physical and psychological well-being (as assessed by the Centers for Disease Control and Prevention [CDC] Healthy Days measure) and health-promoting behaviors, the relationship between vibrator use and women's scores on the Female Sexual Function Index, and an assessment of the frequency and severity of side effects potentially associated with vibrator use. The prevalence of women's vibrator use was found to be 52.5% (95% CI 50.3-54.7%). Vibrator users were significantly more likely to have had a gynecologic exam during the past year (P < 0.001) and to have performed genital self-examination during the previous month (P < 0.001). Vibrator use was significantly related to several aspects of sexual function (i.e., desire, arousal, lubrication, orgasm, pain, overall function) with recent vibrator users scoring higher on most sexual function domains, indicating more positive sexual function. Most women (71.5%) reported having never experienced genital symptoms associated with vibrator use. There were no significant associations between vibrator use and participants' scores on the CDC Healthy Days Measures. Vibrator use among women is common, associated with health-promoting behaviors and positive sexual function, and rarely associated with side effects. Clinicians may find these data useful in responding to patients' sexual issues and recommending vibrator use to improve sexual function. Further research on the relationships between vibrator use and sexual health is warranted.
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A prospective study using two brands of condoms found that of 405 condoms used for intercourse, 7.9% either broke during intercourse or withdrawal or slipped off during intercourse; none of these events were related to condom brand, past condom use or use of additional lubricant. Of the remaining condoms, 7.2% slipped off during withdrawal; slippage was not related to condom brand or past use of condoms, but it was significantly higher when additional lubricant was used.
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Men attending 3 sexually transmissible disease clinics and a university health clinic in Sydney, Australia, were invited to complete a questionnaire on their use of condoms. Respondents were 108 male condom user volunteers aged 18 to 62 years; in the last five years 47 had had sex with men, 18 with both men and women and 43 only with women. They reported using a total of 4809 condoms in the previous 12 months (condoms worn by a male partner were not included). The overall breakage rate was 4.9% (including condoms breaking during application), while 3.1% of condoms reportedly slipped off. On a multivariate analysis, condom breakage correlated with: (1) male sexual partner(s), (2) infrequent condom use, (3) rolling the condom on as per conventional instructions (modified application methods appeared protective) and (4) having trouble with condoms partially slipping. Factors associated with condoms slipping off were (1) young age, (2) being circumcised, (3) having less life-time condom experience, (4) rolling the condom on conventionally, and (5) having trouble with condoms partially slipping. Few men used inappropriate lubricants and no association between lubricant type and breakage was found. Though common among our respondents, negative attitudes towards condoms, loss of erection during condom application or use, finding condoms uncomfortable, and prolonged sexual intercourse were not related to success in use. Almost half (49%) of the men reported having deliberately removed a condom after the beginning of intercourse; 17% had done so 3 or more times. Counselling protocols should acknowledge the complexity of condom use.(ABSTRACT TRUNCATED AT 250 WORDS)
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Infertility affects approximately 15% of couples, and in about one-third the primary cause is a male factor. Patients undergoing infertility investigations frequently experience sexual dysfunction, which often is due to inadequate vaginal lubrication. This can lead to increased use of coital lubricants. The effects of such lubricants on sperm motility have not been widely studied, although sperm motility is one of the best prognostic indicators of fertilization. Using a prospective longitudinal control-based study, we analysed the effect of adding four lubricants: KY jelly, baby oil, olive oil and saliva on sperm motion in 16 samples from patients undergoing infertility investigations. Sperm samples were prepared by density gradient centrifugation prior to mixing with lubricants. Motility parameters were determined using computer-assisted semen analysis after 5, 15 and 30 min. All lubricants except baby oil significantly decreased percentage progressive motility, progressive velocity, curvilinear velocity and lateral head displacement at 12.5% concentration. At a lower concentration of 6.25%, both olive oil and saliva still significantly reduced progressive motility parameters, while KY jelly diminished head movement parameters. Hence, even at these very low concentrations, coital lubricants impair sperm motility and thus may adversely affect fertility.
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While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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This study assessed frequency of rectal lubricant use, opinions about rectal microbicidal gels, and willingness to participate in acceptability trials of rectal microbicides among Latino men who have sex with men (MSM). Latino MSM (N = 307) living in New York City were surveyed from October 1995 through November 1996. Eleven Latino MSM participated in a focus group. Among those having anal sex during the prior year, 93% used lubricants (59% always and 74% in at least 80% of sexual encounters) regardless of condom use. Of the 29 men who practiced anal sed but did not use condoms, 90% used lubricants with similar frequency. Of those using lubricants, 94% used at least 1 teaspoon per occasion. A transparent product, free of smell and taste, was favored. Of the MSM in the sample, 92% said that they would use a lubricant with an anti-HIV microbicidal agent, and 87% expressed interest in participating in an acceptability trial. Product and dispenser preferences also were discussed. A rectal lubricant with microbicidal properties appears acceptable and desirable to Latino men who have anal sex with other men.
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Sexual behaviors are associated with many genital infections, but the role of sexual variables as risk factors for Candida vulvovaginitis has not been clearly determined. To assess the association between sexual behaviors and other risk factors with the presence of Candida vulvovaginitis, we performed a case-control study comparing these potential risk factors in women with and without culture-documented Candida vulvovaginitis in two Midwestern community-based medical offices. Participants included 156 women with Candida vulvovaginitis and 92 controls, ages 18-60. Risk factors for Candida vulvovaginitis, including sexual and partnership behaviors, demographic data, past genital infections, exposures, and diet, were investigated using logistic regression. The presence of Candida vulvovaginitis was positively associated with recent cunnilingus (odds ratio [OR] = 2.22 for five times a month compared with no times, 95% confidence interval [CI] 1.36, 3.84), but was less likely in women who masturbated with saliva in the previous month (OR = 0.30 if masturbated five times vs. no times, 95% CI 0.09, 0.99). Other independent risk factors included knowing the sexual partner a shorter period of time (OR = 1.56 for 1 year vs. 5 years, 95% CI 1.16, 2.13) and lower milk ingestion (OR = 3.57 for no servings vs. two servings per day, 95% CI 2.00, 6.67). Increased number of sexual partners, early age at first intercourse, and increased frequency of intercourse are not related to risk.
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To gain insight into practices that may inform formulation and use of rectal microbicides, in-depth interviews were conducted with an ethnically diverse sample of 28 women who engage in anal intercourse. Microbicides are compounds under development to decrease sexually transmitted infections. Most women practiced anal sex in conjunction with vaginal intercourse. Anal sex typically was not preplanned, and few women reported preparation. Condom use was rare. Most women relied on saliva, vaginal fluids, prelubricated condoms, or used no lubrication at last intercourse. Women were uncertain about the amount of lubricant used during sex, with typical estimates of 1 to 2 teaspoons. This may prove challenging to the formulation and promotion of rectal microbicides, as substantially higher amounts may be required. Additional challenges include infrequent use of packaged lubricants, and typical male lubricant application, which may make women's control of rectal microbicides more difficult. Women overwhelmingly expressed interest in rectal microbicides.
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Data concerning the physiology of female sexual functioning are still obtained from animal studies, but an increasing amount of novel evidence comes from human studies. To gain knowledge of psychological and biologic physiology of women's sexual functioning, mainly addressing sexual arousal and orgasm. A broad-based literature review of current knowledge of the psychological and biologic physiology aspects of women's sexual functioning. A comprehensive understanding of the anatomical, neurobiological, and psychological mechanisms behind sexual function and responses is of paramount importance. A biopsychological paradigm was considered when reviewing currently available data, thus considering aspects of: (i) sexual differentiation of the brain, which is critical for sex differentiation in behavior; (ii) central neurobiology of sexual function, highlighting specific and innovative findings from neuroimaging methods that enable visualization of active brain areas during arousal and orgasm; and (iii) peripheral functional anatomy, mainly addressing genital arousal and orgasm. Translational science was also covered, providing data about the actual role of sexual arousal in women in both procreation/reproduction and recreation/pleasure. The interaction between physiological and psychological states of women's sexual response, nonspecific sexual response, interoceptive awareness, and flexibility of sexual interests have also been addressed. Further research on normal physiology of women's sexual function is needed in order to expand and "translate" current knowledge into the pathophysiological clinical setting. This manuscript encompasses data presented at the 3rd International Consultation on Sexual Medicine in Paris, France, July 10-13, 2009.
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Data from an Internet-based survey of 1,197 women who facilitate in-home sex toy parties in the United States were analyzed to explore facilitators’ potential to serve as resources for sexual health promotion. Findings indicate that many facilitators had had sexuality education or work experience related to health, education, or sexuality. Also, intensive sexuality education in high school, college, or from a workshop/seminar was significantly related to facilitators’ being asked questions about condoms (p < .01), lubricants (p < .01), and health-related sexuality topics (p < .01). These results have implications for facilitators, corporate entities, and sexual health professionals who collaborate to enhance the sexual health of their communities.
Article
Introduction: Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset. Aim: To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence. Methods: Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum. Main outcome measures: The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset. Results: Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain. Conclusions: Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain.
Article
Although studies of specific groups of individuals (e.g., adolescents, "high risk" samples) have examined sexual repertoire, little is known, at the population level, about the sexual behaviors that comprise a given sexual encounter. To assess the sexual behaviors that men and women report during their most recent sexual event; the age, partner and situational characteristics related to that event; and their association with participants' evaluation of the sexual event. During March-May 2009, data from a United States probability sample related to the most recent partnered sexual event reported by 3990 adults (ages 18-59) were analyzed. Measures included sexual behaviors during the most recent partnered sexual event, event characteristics (i.e., event location, alcohol use, marijuana use, and for men, erection medication use), and evaluations of the sexual experience (pleasure, arousal, erection/lubrication difficulty, orgasm). Great diversity exists in the behaviors that occur during a single sexual event by adults, with a total of 41 combinations of sexual behaviors represented across this sample. Orgasm was positively related to the number of behaviors that occurred and age was related to greater difficulty with erections and lubrication. Men whose most recent event was with a relationship partner indicated greater arousal, greater pleasure, fewer problems with erectile function, orgasm, and less pain during the event compared with men whose last event was with a nonrelationship partner. Findings demonstrate that adults ages 18 to 59 engage in a diverse range of behaviors during a sexual event and that greater behavior diversity is related to ease of orgasm for both women and men. Although both men and women experience sexual difficulties related to erectile function and lubrication with age, men's orgasm is facilitated by sex with a relationship partner whereas the likelihood of women's orgasm is related to varied sexual behaviors.
Article
In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives. This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50. Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined. Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience. Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participant's evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to men's evaluation of the experience. Relationship status was the most consistent predictor of women's evaluation of the experience. Condom use rates remained low for participants across age groups. Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.
Article
Bacterial vaginosis (BV) is a common cause of vaginitis and, for unknown reasons, is common in lesbian and bisexual women. We defined risks for prevalent BV in lesbian and bisexual women with attention to detailed sexual risk history. Women 16 to 35 years reporting sex with > or = 1 woman in prior year underwent computer-assisted self-interview with extensive sexual and medical history. BV was defined by Amsel criteria, and associations with subject characteristics were estimated by Poisson regression and generalized estimating equation to adjust for potential coenrollment of current sexual partners. Of 335 participants (median age, 25 years; 22% nonwhite race), 6% reported douching, 24% sex with men, and 91% any sex in the prior 3 months. 96 (29%) had BV, 40% of whom reported corresponding symptoms. BV was associated with reporting a partner with BV (39% vs. 12%; multivariate relative risk [MRR], 4.53 [2.59 -7.93]), vaginal lubricant use (59% vs. 21%; MRR, 1.86 [0.94 -3.68]), or sharing vaginal sex toys in prior 3 months (33% vs. 21%; MRR, 1.70 [0.96 -3.01]). No association was seen for age, race, smoking, hormone use, douching, vaginal, anal or oral sex, or numbers of new partners. Lubricant use and shared vaginal toys were correlated (Spearman 0.29). BV is associated with practices that efficiently transmit vaginal fluid and with use of vaginal lubricant; since these are correlated, assessing independent effects will require further analysis. More research is required to understand relationships between role of transmission of BV-associated bacteria and vaginal lubricant on BV pathogenesis.
Article
Women's sexual dysfunction includes reduced interest/incentives for sexual engagement, difficulties with becoming subjectively and/or genitally aroused, difficulties in triggering desire during sexual engagement, orgasm disorder, and sexual pain. To update the recommendations published in 2004, from the 2nd International Consultation on Sexual Medicine (ICSM) pertaining to the diagnosis and treatment of women's sexual dysfunctions. A third international consultation in collaboration with the major sexual medicine associations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Twenty one experts from six countries contributed to the Recommendations on Sexual Dysfunctions in Women. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence based recommendations for further revisions of definitions for sexual disorders are given. An evidence based approach to management is provided. Extensive references are provided in the full ICSM reports. There remains a need for more research and scientific reporting on the optimal management of women's sexual dysfunctions including multidisciplinary approaches.
Article
Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed.
Article
There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness. To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians. Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome. The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand. Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician. Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.
Article
Although American women are living longer after a breast cancer diagnosis, they may experience significant alterations in sexual function. However, little is known about the types of strategies that women are interested in using to address these sexual issues. This study used a reliable and valid instrument, the Sexual Function Questionnaire, to assess survivors' sexual function. Data were collected from 115 women who were younger than 50 years at diagnosis. Compared to normative controls, survivors scored significantly lower, indicating lower functioning, on most subscales of the Sexual Function Questionnaire and the overall measure, with the exception of the masturbation subscale on which they scored significantly higher. Most participants indicated moderate or strong interest in sexual enhancement products and comfort purchasing sexual enhancement products through various venues. Nurses and other health professionals might consider collaborations with entities of the adult retail industry to provide survivors with information about sexual enhancement products and their therapeutic potential.
Article
Traditional vaginal lubricants have been shown to adversely affect sperm motility. Astroglide, a new vaginal lubricant, and K-Y Jelly were tested at varying concentrations to assess their suitability for infertility patients requiring a lubricant. The vaginal lubricants tested impaired sperm motility in a concentration-dependent but not time-dependent manner. We conclude that all traditional vaginal lubricants should be avoided in patients desiring conception. Future studies should attempt to mimic in vivo conditions and focus on concentration-dependent effects.
Article
As little as sixty seconds' exposure of commercial latex condoms to mineral oil, a common component of hand lotions and other lubricants used during sexual intercourse, caused approximately 90% decrease in the strength of the condoms, as measured by their burst volumes in the standard ISO (International Standards Organization) Air Burst Test. Burst pressures were also reduced, although less dramatically. Lubricants such as Vaseline Intensive Care and Johnson's Baby Oil, each containing mineral oil, also affected condom integrity. Five min. exposure of condoms to glycerol, a frequent component of hand lotions and 'personal lubricants', did not significantly affect burst volume or pressure. Aqueous nonoxynol-9 spermicide did not affect either burst index. The implications of these results for contraception and protection from sexually transmitted diseases, including AIDS, are discussed.
Article
Sexuality is an important part of health, quality of life, and general wellbeing. Studies indicate that less than half of patients' sexual concerns are known by their physicians, and physicians are unaware of how common these sexual concerns are in their practices. Our objective was to determine the prevalence and type of sexual concerns among women seeking routine gynecological care. We mailed the survey in waves. Of 1480 women seeking routine gynecological care from the departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center between August 1992 and January 1993, 964 responded. The main outcome measures were self-reported sexual concerns and their experiences with discussing these concerns with a physician. A A total of 98.8% of the women we surveyed reported one or more sexual concerns. The most frequently reported concerns were lack of interest (87.2%), difficulty with orgasm (83.3%), inadequate lubrication (74.7%), dyspareunia (71.7%), body image concerns (68.5%), unmet sexual needs (67.2%), and needing information about sexual issues (63.4%). More than half reported concerns about physical or sexual abuse, and more than 40% reported sexual coercion at some point in their lives. Our results suggest that sexual health concerns are prevalent for women seeking routine gynecological care. Sexual health inquiry should be a regular and important part of health care maintenance.
Article
Human sexuality is more than sexual function. It is an ever-changing lived experience affecting the manner in which we view ourselves and our bodies. Most health professionals fail to address sexuality in the clinical setting and feel more comfortable focusing on treatment outcomes, such as the management of treatment side effects, than in addressing issues related to sexual behavior. Perhaps this is because many health professionals are uncomfortable about initiating a topic regarding a person's sexuality, or because they are unsure of their knowledge relating to changes in a person's sexuality after the management of cancer. Cultural issues in our society, such as the myth that older women with breast cancer are no longer interested in sexuality and intimacy, and the presumption that issues of survival overshadow sexuality, provide barriers to open communication about sexuality in women with breast cancer. Sexuality in the patient with breast cancer needs to be addressed by the nurse irrespective of the woman's age, partnership, and disease status. Knowledge related to changes in a woman's sexuality and intimacy after the management of breast cancer are explored, and strategies are provided for the nurse to use in communicating openly about sexuality in the clinical setting.
Article
This paper reports on the common experience of vaginal wetness amongst South African users of progestogen-only injectable contraceptives. The observations emerged in the course of a community-based cross-sectional household survey undertaken in a rural district of KwaZulu-Natal in South Africa. The purpose of the survey was to elicit self-reporting on side effects of injectable contraceptive methods. Eight hundred and forty-eight women aged 15-49 were interviewed and 22.1% reported current use of an injectable contraceptive method, either depot medroxyprogesterone acetate (Depo-Provera) or norethisterone oenanthate (Nur-Isterate). Other modern methods used were oral hormonal contraceptives (4.5%), male condoms (1.3%), the intrauterine device (0.1%), and tubal ligation (0.1%). Vaginal wetness was reported by 18.4% of users and was one of the most common side effects, second only to amenorrhoea (62.5%). It was also what 17.5% of the women liked least about using this method. According to almost half the respondents, men regard women who use the injectable contraceptive as "wet", "cold" and/or "tasteless". These survey findings were supported by participants of 14 focus group interviews held in the sub-district. Since some South African men may prefer dry sex the perception that the injectable contraceptive increases vaginal wetness may be problematic for women who use it. Whilst vaginal wetness can only be classified as a subjective side effect at this stage, further investigations are needed as many South African women opt to use this method.
Article
Context: Vulvodynia is a term used to describe chronic burning and/or pain in the vulva without objective physical findings to explain the symptoms. The terminology and classification of vulvodynia continue to evolve, and much remains to be understood about the prevalence, pathogenesis, natural history, and management of this distressing condition. Starting point: James Aikens and colleagues showed that chronic vulval pain (vulvodynia or vulvar dysaesthesia) is associated with worse depressive symptoms (Am J Obstet Gynecol 2003; 189: 462-66). However, the increased scores for depression in this case-control study were attributed to sexual disinterest and experience of chronic pain rather than to features of depressive disorder. These results lend weight to the increasing need for better understanding of the pathogenesis of vulval pain and how to manage it appropriately. WHERE NEXT? The aetiology of vulvodynia and effectiveness of treatments need further study. Appraising the available literature, we have formulated a useful approach to patients with chronic vulval pain. There is a pressing need for further case-control studies of potential causes of vulvodynia and for randomised trials of interventions.
Article
It has been shown that men who have sex with men actively seek lubricants that contain nonoxynol-9 (N-9) because they believe that N-9 may help to prevent infection by HIV. However, indirect evidence suggests that N-9 may actually enhance infection. Microscopic examination of rectal lavage and biopsy specimens collected at different time points following rectal application of a lubricant containing 2% N-9 showed rapid exfoliation of the rectal epithelium. Because the rectal epithelium protects target cells in the submucosa from HIV, we conclude that lubricants containing N-9 should be avoided during rectal sex.
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To explore the extent to which adult retail stores may contribute to a community's sexual health promotion infrastructure, we collected data from 294 customer service employees of 80 adult retail stores in 61 U.S. cities. Findings indicated that these stores and their employees do possess at least a baseline level of characteristics that indicate they are serving, or have the potential to serve, as sexual health resources in their communities. As researchers and practitioners continue to explore new and effective mechanisms for responding to sexual health issues, they should consider outlets such as adult stores. Enhancing the capacity of these stores to contribute to sexual health may require strategic collaborations between sexual health researchers, sexual health practitioners, and the adult retail industry in order to develop initiatives that are responsive to the unique goals and cultures of each.
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Article
Research on vaginal microbicides for HIV prevention is progressing rapidly; the first large-scale effectiveness trials were launched in 2004. The majority of candidate microbicides are formulated as gels, which will act as lubricants when used during sex. Preferences and practices regarding lubrication during sex, therefore, likely influence microbicide acceptability and use. Researchers seek to maximize consistent and correct use of candidate microbicides during clinical trials to enable valid estimates of product effectiveness, and if proven effective, microbicides will be widely used only if acceptable. We conducted a comprehensive literature review and interviewed 13 key informants from nine countries in Africa, Asia, Latin America, and North America. We found that norms and practices regarding lubrication during sex exist in many different countries. Despite significant variation, common themes emerged. In the majority of countries, women's genital hygiene is highly valued, and women are expected to achieve a moderate amount of vaginal lubrication during sex that is neither excessive nor inadequate. Women may try to achieve this by engaging in a wide variety of vaginal practices. Even though some informants expressed concerns about the acceptability of lubricating microbicides in some settings, they thought that microbicides should be developed, that women and men may be willing to accept a certain level of increased lubrication in exchange for protection from HIV, and that lubricating microbicides may be considered more acceptable when perceived as genital hygiene products. Recommendations are made on how to take vaginal practices into account during clinical testing of microbicides.
Article
This study compared failure rates of a standard-sized condom and a condom fitted to a man's penile length and circumference and assessed users' perceptions of condom acceptability and confidence in the efficacy of both condoms. Using an experimental crossover design with Internet-based daily diaries, 820 men who wore at least one of each condom type reported outcomes and perceptions of condoms used during vaginal and anal intercourse events for which they were the insertive partner. Breakage for fitted condoms (0.7%) was significantly less than for standard-sized condoms (1.4%). When assessed by penile dimensions, significantly less breakage of fitted condoms than standard-sized condoms was observed among men in the middle circumference category (12-13 cm) during anal intercourse (1.2% versus 5.6%), men in the larger circumference category (> or =14 cm) during vaginal intercourse (0.6% versus 2.6%), and men in the longer length category (> or =16 cm) for both vaginal (0.5% versus 2.5%) and anal (3.0% versus 9.8%) intercourse. More slippage upon withdrawal after vaginal intercourse occurred with fitted condoms among men in the middle penile length (1.9% versus 0.9%) and circumference (2.2% versus 0.7%) categories. Fitted condoms may be valuable to sexually transmitted infection prevention efforts, particularly for men with larger penile dimensions. That fitted condoms slipped more for some men provides insights into the need for unique educational materials to accompany such products. Findings also highlight the need for participatory approaches between public health, condom manufacturers, and the retail industry to integrate fitted products into our work successfully.